Annual Representative Meeting 2003
Stories from the meeting
Monday 30 June
Profit motive distorts patient care
There should be no place for a US-style system of healthcare in the NHS, doctors have said.
London specialist registrar in anaesthetics Anne Hunningher warned the government was replacing the NHS with a private-provider market based on the US set-up.
She said the profit motive fragmented institutions and distorted clinical freedom and patient trust.
She said: ‘The US model is a disaster for patients, professionals and public health and there is absolutely no evidence that it will improve healthcare. GATT and WTO policies, coupled with the NHS Plan and foundation hospitals is privatisation. This is a battle for universality and we must not lose it.’
BMA Welsh council chairman Tony Calland said: ‘This highlights the greatest threat yet to the art of doctoring and the ethos of the NHS.
He pointed developments that showed the direction in which things were moving, including former health secretary Alan Milburn’s trips to the USA, foundation hospitals, the independence of primary care trusts and the introduction of appraisal and revalidation.
(Source: BMA News)
Doctors unite against foundation hospitals
Foundation trusts will destroy equality in the NHS and leave other hospitals to ‘wither on the vine’ , doctors have warned.
In a debate which cemented the medical profession’s unity on the issue and answered BMA council chairman Ian Bogle’s call for a clear policy to take forward to the government, Kent consultant general surgeon Andrew McIrvine said foundation trusts would destroy equality in the health service and that national terms and conditions would no longer apply.
He said:: ‘I fully understand the frustration people have with the existing micro-management from Whitehall.
He said local people would have little input and that the hospitals would be controlled by private companies. ‘Private corporations will set yet more targets, will watch us even more closely.’
He added that the focus would be on profitable operations and that expensive or risky operations would be discouraged.
Leicester consultant in cardiac anaesthesia and critical care Geoffrey Lewis was concerned that since Wales had decided not to have foundation hospitals, doctors would leave to work in trusts over the English border.
(Source: BMA News)
Scrap ‘simplistic and damaging’ star ratings, say doctors
By Mike Foster, BMA News
Doctors overwhelmingly agreed the star-rating system of grading hospitals should be scrapped because it fails to measure clinical care and focuses too much on statistics.
North London GP Chaand Nagpaul, who led a call on the government to abolish star ratings, said the system is a ‘simplistic and damaging approach’ that has already been discredited by the NHS Confederation, the Audit Commission and the Dr Foster group.
Dr Nagpaul said: ‘It uses indices lacking in validity, parameters devoid of quality and targets that satisfy political ends, rendering them meaningless.
‘There is disproportionate focus on surgical and discharge performance, but no measure of the quality of care contained within these statistical episodes, such as whether an elderly patient with a stroke discharged early actually received necessary rehabilitation before discharge.’
He added targets to reduce waiting times ‘perversely reward those willing to provide cursory, conveyor-belt consultations of high volume and low quality.’
Most doctors at the annual representative meeting in Torquay supported Dr Nagpaul’s view that the current system rates trusts as homogenous units without recognising the different standards of care between individual services and does not take account of case mix or deprivation.
Dr Nagpaul said: ‘A cardiac centre like Harefield Hospital is quoted as having a four times greater risk on death after surgery, ignoring the obvious fact that as a tertiary centre it deals with higher risk patients. And cancer mortality rates are not adjusted for deprivation despite the government’s own report on inequalities linking cancer with social class.’
Surrey consultant radiologist Tiz North said her trust went from zero to two stars just because it spent money on new computers and gave the hospital a new coat of paint, but this did nothing to boost staff morale.
Dr North said: ‘Clinical excellence at the hospital has not changed one iota.
‘I think these measures should be absolutely specific and understood by the public.’
Doctors say A&E waiting targets warp clinical priorities
Four-hour waiting targets in A&E departments damage patient care and give no long-term benefits, doctors said.
They called on the BMA to lobby the government to change its system that means from next year 100 per cent of A&E patients in England will have to be dealt with within four hours.
Sunderland senior house officer in A&E Emma Bywaters said money spent on desperate measures to meet the government’s 90 per cent deadline at the end of March would have been better spent on long term improvements.
She added: ‘We try to practise evidence-based medicine. There is no evidence that this target will improve patient care.
‘There is a group of patients who require a brief period of observation. If 100 per cent of patients are to be out of the door in four hours, these patients will have to be admitted. This will have huge implications in terms of bed pressure and duplication of work.’
Kent A&E specialist registrar Simon Calvert said patients with minor problems had been prioritised over unwell patients or those with complicated problems in order to meet the targets.
BMA junior doctors committee joint deputy chairman Simon Eccles, a London A&E specialist registrar, said the week-long audit had been a farce, adding that at his own hospital, success rates in meeting the target had dropped to below 50 per cent afterwards.
He said: ‘Patients are waiting longer for treatment than they need. Patients are getting lost in the system and care is being compromised.’
(Source:BMA News)
Private funding 'vital' to primary care development
The private finance initiative remains an ‘enormously expensive way’ of funding new building programmes in the NHS, doctors agreed this week.
But they stopped short of recommending a wholesale campaign against the controversial scheme, as called for by London consultant general surgeon Anna Athow, because GPs who are independent NHS contractors have always relied on such initiatives for surgeries and health centres.
Mrs Athow said: ‘PFI is an enormously expensive way of financing the provision of new buildings.
‘The NHS is being mortgaged to private companies.’
But London GP Laurence Buckman said: ‘GPs provide the best care from the best premises. These were never built by health authorities and it is only private finance that keeps them going.’
(Source: BMA News)
Primary care funding soaked up by hospital deficits, say doctors
Strategic health authorities should stop ‘robbing Peter to pay Paul’ and ensure primary care trusts spend the bulk of new NHS funding in primary care.
Leeds GP Elizabeth Jarvis said funding promised to GPs and primary care had too often been absorbed by hospital deficits.
Dr Jarvis said: ‘Time and time again, the money is spent before it arrives in primary care. So often, all the GP hears is excuses.’
Birmingham GP Fay Wilson said primary care is the ‘unglamorous, unregarded but essential foundation which keeps the rest of the building up’ in the NHS.
Dr Wilson said diverting primary care funds to secondary care also has an impact in that it hides the real need in hospitals.
However, a call for most new funding to be ring-fenced for primary care faced fierce opposition.
Stockton-on-Tees specialist registrar in obstetrics and gynaecology Fiona Kew said: ‘I agree that some of the money is falling into the bottomless pit of hospital services but the solution is not to plough all the money all the time into primary care.’
Miss Kew added that ultimately the money is used to treat patients.
‘It is folly to be prescriptive about what proportion should be spent where. We should spend where it is needed,’ she said.
(Source: BMA News)
Doctors and lawyers ‘should understand each other better’
Strained relations between doctors and lawyers should be tackled by a joint effort to educate each side about the other, doctors have agreed.
Derbyshire GP John Grenville suggested the BMA and the Law Society should set up a working party to examine the problems that can arise at the ‘medical-legal interface’ such as GPs appearing as expert witnesses or preparing reports.
He told the ARM: ‘We don’t understand what each other does. We need something that looks at the nuts and bolts of what happens when there is an interaction.’
Although the original call for action came from the local medical committees conference and therefore related only to GPs, BMA medical ethics committee chairman Michael Wilks promised to investigate the issues relevant for all doctors.
(Source: BMA News)
Unfair prescription charge system needs review
By Lisa Pritchard, BMA News
The system of prescription charges needs reviewing to remove inequalities, doctors have agreed.
Lothian GP Stuart Blake won a great deal of support for his suggestion that prescription charges should be abolished altogether because they were at odds with the concept of the NHS being free at point of delivery.
But doctors at the ARM ultimately did not back his call, preferring instead to demand a review.
Cardiff locum GP and associate specialist in genetics Jane Fenton-May said, in the recent Welsh Assembly elections, Labour campaigned on a free prescriptions platform and doctors were optimistic charges would soon be abolished.
The BMA has long campaigned for a change in prescription charges and the categories which exempt people from paying because of the number of anomalies -- for example, a diabetic with chronic bronchitis is exempt from charges while a chronic bronchitic with heart failure must pay for all prescriptions.
Subscriptions up 5.1 per cent
The standard rate of subscription to the BMA will increase by 5.1 per cent with effect from October 1 this year, doctors have agreed. It will rise from the current £318.72 to £335.04. Doctors said the rise was necessary to meet the association’s financial commitments.
(Source: BMA News)
Managers facing ‘deplorable’ target pressures
The severe and unfair pressures on senior managers to produce results matching pre-set political targets have been condemned as deplorable by doctors.
Doctors said they believed in honesty and that the pressure could result in dishonesty.
Lancashire obs and gynae consultant Alan Russell said managers were under extreme pressure to meet targets.
He said: ‘Most of us who have been involved in management have the relative luxury of returning to clinical work.’ But he added that this option was not available to managers, who were in a ‘no-win’ situation.
Lancashire ENT consultant surgeon John Brandrick said: ‘This is a ploy for civilised behaviour from people who ought to behave in a civilised way.’
He said the present philosophy was that the end justified the means, which had always been shown to be wrong. He added that he was pleading for honest behaviour in place of tyranny and dishonesty.
Doctors also welcomed the recent Audit Commission report on targets and strongly agreed that they distorted clinical priorities and could harm patients.
(Source: BMA News)
SAS doctors’ skills ignored
The skills of staff and associate specialist doctors are being overlooked in the face of the government’s drive to recruit consultants from overseas, doctors agreed.
And they said SAS doctors should be given the opportunity, and the legislation amended if necessary, so that they could be included on the specialist register.
Lincolnshire staff grade anaesthetist Anthea Mowat said: ‘There are many associate specialists and senior staff grades not only willing but professionally able to take on the responsibility of consultant seniority provided they are given the opportunity to do so.’
She said SAS doctors could fill much of the workforce gap overnight with great skill and competence, adding: ‘Must international recruitment then continue, or should there be proper and reasonable accommodation of home resources?’
Watford consultant paediatrician Keith Brent said it was ‘plain daft’ to go looking overseas spending a great deal of money on recruitment when there were committed doctors on the doorstep who had worked within the system.
Birmingham consultant radiologist Nalin Chokshi led the call for SAS doctors to be given the chance to be included on the specialist register.
Joint Consultants Committee chairman James Johnson said the Postgraduate Medical Education and Training Board would be a unique opportunity for SAS doctors to progress to the register as, for the first time, their experience would be taken into account.
(Source: BMA News)
Doctors call for NHS Direct translation role
Translation services for non-English speaking patients is ‘woefully inadequate’ and doctors agreed NHS Direct should get involved to improve communication.
Cardiff specialist registrar in neurology Trevor Pickersgill said patients and doctors should not be separated by language barriers.
Doctors agreed translation should be provided through NHS Direct and called for a national medical translation service.
Dr Pickersgill said: ‘Let us try and enfranchise the disenfranchised.’
(Source: BMA News)
Doctors call for tough penalties on violent patients
Patients who attack doctors and other NHS staff should face penalties as harsh as if they had assaulted a police officer, doctors said.
Lancashire specialist registrar in anaesthetics Matilda McLoughlin said despite all the posters put up in hospitals advertising zero tolerance to violence against staff the reality on the ground is still undermining patient care and professional safety.
Dr McLoughlin said she knew of one case in which a consultant paediatrician was awarded just £10 in damages following an assault by a parent because the judge ruled the parent was ‘stressed’.
London consultant in occupational medicine Paul Grime said access to quality occupational health services in every trust was crucial to counter cases of harassment and encourage doctors to speak out.
Dr Grime said: ‘We need a system for dealing with these complaints, so that we can nip them in the bud.’
Doctors also deplored the failure of primary care organisations to provide safe rooms where violent patients could be treated without risk to staff.
(Source: BMA News)
Licensing body call for managers rejected
A call for a licensing body to oversee managers, chairpersons and board directors involved in health management was rejected as being too confrontational.
Retired Berkshire senior clinical medical officer in community medicine and child health Joan Black said managers were now the most powerful group within the healthcare system and yet they did not report to a general council or face ‘erasure’ from a register if they perform poorly or misbehave.
BMA junior doctors committee chairman Paul Thorpe said cases such as the chief executive of a trust who negotiated an eight-year deal with a company to provide computer services, who later left to sit on the company’s board, abusive language in written communication, and an outgoing chief executive not telling his successor that he was inheriting a debt-ridden trust demonstrate the need for a general council for the governance of health service management.
However, Cardiff public health consultant Eddie Coyle said he believed the idea was ‘unhelpful’. He said: ‘We need a more mature relationship with managers.’
BMA council chairman Ian Bogle said: ‘If we are going to move this forward without getting into a slanging match with managers we need to discuss this with the NHS Confederation.’
(Source: BMA News)
Doctors back 'no fault' compensation
Doctors strongly backed no-fault compensation for the victims of medical errors as the government published proposals for a new clinical negligence system.
The system favoured by doctors would go further than the government’s proposals for a scheme of no-fault compensation with maximum financial limits.
Swansea consultant obstetrician Paul Flynn said fear of litigation overshadowed the practice of all doctors and needed to be removed.
Devon public health consultant Noel Olsen said it was important that no-fault compensation – which should also be ‘non-stigmatising for doctors’ - was made distinct from medical negligence, which should still be investigated by clinical governance.
The consultation paper by chief medical officer for England Professor Sir Liam Donaldson, Making Amends, sets out proposals for fundamental reform of the way the NHS handles clinical negligence cases. It is designed to move away from a climate of fear that prevents clinicians from reporting mistakes to one of openness from which lessons can be learned.
An NHS Redress Scheme would be established to provide investigations when things went wrong, remedial treatment, rehabilitation, explanations and apologies, and financial compensation where appropriate. A national body, building on the work of the NHS Litigation Authority, would oversee the scheme and manage financial compensation at a national level.
Statutory provisions would introduce a ‘duty of candour’ on clinicians and managers to inform patients about actions that have resulted in harm. Those who reported adverse events or medical errors would be exempt from disciplinary action except where there was a criminal offence or where it would not be safe for the clinician to continue treating patients.
Sir Liam said it was important to get away from the culture of blame in the NHS. He said: ‘If the first reaction to something going wrong is to suspend or discipline someone then their instinct will be not to report it.’
(Source: BMA News)
Doctors condemn government over MMR failures
Doctors have condemned the government for its failure to convince the public that the MMR vaccine is safe.
They also said the target payment system contributes to parents’ lack of confidence because they perceive doctors have a financial interest in recommending it.
But doctors at the ARM did not back a call for the UK’s four chief medical officers to resign. BMA Welsh council chairman Tony Calland said: ‘This is the BMA’s showcase conference. Actually passing this would be extremely unhelpful in some of the devolved nations. It is very important for the good relations we have with the Welsh Assembly and the CMO to continue.’
BMA council chairman Ian Bogle added: ‘I believe this body is not at its best when it calls for the resignation of its colleagues.’
(Source: BMA News)
Doctor forced to buy own equipment in bullying scandal
By Lisa Pritchard, BMA News
A consultant had to give his own credit card details to buy essential medical equipment as a patient lay on the operating table because his managers were arguing over the bill.
Another doctor with a faulty diathermy machine was told by managers he would just have to cope.
The shocking stories were uncovered by central London consultant radiologist Jacky Davis in her research on bullying and intimidation in the NHS.
But she said none of the doctors concerned did not feel confident enough within the NHS culture to go public with their experiences.
She said: ‘Culture and bullying has spread from the top.’
BMA Welsh GPs committee chairman Andrew Dearden said that in primary care, practices had been leaned on to persuade them not to apply for money due to them for extra responsibilities. He said practices had been told by primary care organisations that staff would be withdrawn, that surgeries would be deprived of development or new investment money – or even that doctors would find themselves on the ‘wrong side of some investigations’.
GPs urged to find strength in unity
By Mike Foster, BMA News
GPs have agreed they must speak with one voice and not allow their differing contracts to cause divisions.
Portsmouth GP Julian Neal said it was best for family doctors and their patients if the profession was united across the UK and across general medical services and personal medical services contracts.
Dr Neal said 30 per cent of GPs were now in PMS contracts which could rise to 50 per cent, but this should not be seen as a ‘faultline’ along which GPs could be ‘divided and ruled.’
Doctors also called on the Department of Health to clarify by September the exact mechanism and funding for PMS doctors to return to the new GMS contract and whether PMS practices on a ‘mainstream statutory basis’ would have a permanent option to return to GMS at any time.
GPC joint deputy chairman Hamish Meldrum said the issue was somewhat unclear as one DoH official reportedly said: ‘In this case permanent does not mean forever, it just means one or two years.’